Friday, September 5, 2008

Between naivete and paranoia exists conscious bliss

Christian came to visit my second to last week in Malawi, and we spent the week traveling. It was a very different experience for me to spend a week as a tourist, a traveler, as opposed to someone who lives and works in one place. I'm glad I got to experience both.

The hardest part of traveling in Malawi is the "how" of traveling. Since we don't "drive british" (or on the left side of the road) we decided not to rent a car. (and even when things got hairy and we looked into renting a car, it was very expensive, even for U.S. standards). So we took public transport, at least on the way there. While public transport is really getting in there with the local people and seeing what their day to day life is like, and it's fun and you come away with great stories, it's also very dangerous for a variety of reasons. It's dangerous because the buses are driven till they literally fall apart (many of them have doors held on by bungee cords and the like), they are stuffed chock full of people, who are usually accompanied by their children, bags of groceries, clothes, things to sell, chickens, etc. and the drivers are pretty fast and reckless.

So, yes, it's a very colorful, "African" experience, and truth be told, I love those memories...the beautiful scenery flying by, the wind blowing the hot stale air. (I'm sure the fact that I basically passed out every time I got on one helped to ignore the the U.S. I also fall asleep easily in moving vehicles, but for some reason it was amplified in Malawi and I couldn't help but be lulled into slumber.) But then there is the side of me that just hopes nothing happens and I don't regret getting on the bus. It's all about finding your comfort level with such things in Africa. On the one hand, you think people do this everyday. But they don't necessarily have a choice. And I don't need to put myself in harm's way if I have other options. It's really about weighing how dangerous something actually is.

I am happy to say that I now remember the anxiety I was feeling about traveling to and about Malawi--because since I am remembering it, it is something that has left me. I definitely went through this odd phase before I left for Malawi where I was very anxious and scared about things, and it really annoyed me. I worried that it was because I was getting "older". But I will tell you that everything to hear and read about Africa in America definitely contributed.

It was such an interesting experience to see Malawi through the eyes I have now, and compare that with the eyes I had when I went to Mali three years ago. When J and I attended the West African dance class and then saw the trip to Mali, Africa was a new idea. The opportunity appeared, and it seemed right, and exciting. I didn't even know that Mali was a country till I heard about the trip.

In Mali I became smitten with Africa, and learned everything I could over the next three years, including the names of all 54 African nations. So this time around I had heard plenty about the poor road conditions, the number of people that die, and the diseases. So to be honest, I was feeling a little on the paranoid side when I left, which was not normal for me. What this does speak to is the saying that "Ignorance is bliss" but also that "Knowledge is power" and that there is a delicate balance to strike between the two--which is more like a dance, as it moves, flows and evolves.

So what I've been trying to say is that I found that balance for myself in Malawi.In Mali I was too naive and before leaving for Malawi I was too paranoid. I noticed a little anger with myself this time around for finding fun in dangerous situations in Mali. For instance, I rode around on Madou's motorbike with no helmet, something I would never do in the States. Truth be told, we never went on the highway and probably never went above 30 just riding around town. Still. But I have changed my ways and will not ride om a bike without a helmet no matter what country I am in. In fact, I probably could have done so in Malawi but did not. I was happy to see that more people seemed on board with wearing helmets there. Luckily being back in Africa I was able to relax and use my knowledge (and a few trips to the hospital to make sure I didn't have malaria helped. In fact, I still ask to be tested for malaria every time I go to the doctor even here, and it's definitely a sensible thing to consider after traveling to particular areas).

And so I say all this for you who are intrigued with traveling to Africa, or other places, but feel held back by all you hear. I also like to keep in mind that there are dangers anywhere, and while I worried about some things in Malawi I would never worry about here, there are also dangers to consider in parts of the U.S. that are not a concern in Malawi. There are many dangers to be taken seriously in Africa, and I lived responsibly according to those, but I was also free to enjoy myself, to live and learn and experience within those parameters. So I hope that is what you can find also, in your adventures, whether they take you to the next town over or across the world.

Back in the U S of A

I am back now and I hit the ground running with the normal whirlwind tour a visit to Chicago is, maybe even more so with two weddings and the associated activities. I held up pretty well, though I never took a breather and nearly fell over after I reached California and got off the plane and started learning to drive stick shift! :) Life is definitely slowing down now, but it was great to have that "booster" of family and friends in Chicago. So, America wasn't too much of a shock, probably because I had been to Africa before and already had the eye opening experience of returning back to the land of over-abundance (in a material sense).

So what moments have struck me? Sitting at the dinner table my first night back, in Chicago with my family, I was full and thought to give my leftovers to someone outside (Sam and I always gave our leftovers to our guard, who stayed outside the house) but in our middle class neighborhood, there would be no one on the street to give my food to.

I also had this "space" moment since being in L.A...I was going to a school for work, and I was the only person outside in this expanse of streets, houses, cars and a Blantyre, there would be lots of people in that space. And, of course, I am in California, which is one of the most purposely spaced places in the country.

I think I remembered to appreciate my first automatic hot shower (just turning the knob, rather than having to boil water first) and I also noticed my first night sleeping without a mosquito net...although sleeping under the mosquito net was kind of like a nice cocoon, it was just a lot of work getting in and out of bed.

I definitely went on a funny food thing, like wanting everything and anything at once, like Janine and Dan having to watch me eat a milkshake, cheese sticks and half of a burrito at a diner after Danie & Kirby's wedding...:) And the night that I had two dinners! One with my family in South Bend, and another out with Timothy that night. (For the sake of not looking like a glutton, I didn't eat much at the first meal :)

Ah, speaking of gluttony, and America, or rather consumerism ... Consumerism is something I did not miss. I was so happy with whatever I had in Malawi. There weren't coffee shops on every corner beckoning me to spend four dollars on a drink. And then if I "give in" to it, I feel guilty. Luckily I'm at a place where I am happy with my body, so at least it's not double guilt, just guilt for spending money.

Maybe the money thing does relate to how as Americans, we are alone more often. As I mentioned above, there were always people around in Malawi. Even outside the city in the villages... well, I'm sure if I was a Malawian who lived in the bush, I could find myself alone. But for me, I was always with other co-workers firstly, and secondly, white people are not a common occurrence in rural areas, so I know wherever I am, people will appear.

The fact that there are always people around was one of the things I discovered and enjoyed about Africa when I was in Mali. I like that if I want to be alone, I can be, but if I want to be with people, even if we are doing our own thing and it's just about company, there is always that opportunity. It just feels much more natural, much more real life, than the contrived feeling of empty streets and sidewalks in California.

Here in L.A. as a newly single person with only so many friends here, I'm alone a lot, so I'll do things like go to or rent a movie, or yoga class, or a coffee shop...all things that cost money! Hence, the connection... sometimes it seems like in America, if we want to be around other people, we have to do something that costs money.

(Ok, exceptions being parks and the beach, which I choose to embrace this weekend, since it is HOT in L.A...and for all those people who asked where my tan was since I was in Africa but it was winter :)...I'm stealing the last bits of summer rays I can).

Tuesday, August 12, 2008

Preventing Mother to Child Transmission

Despite being largely preventable, mother-to-child transmission of HIV accounts for 30 percent of all new infections in Malawi and is the second major mode of transmission after unprotected sex. Every year, an estimated 30,000 babies are born HIV positive.

Relatively simple interventions to lower the risk of infection are available to only a small number of women and lag far behind the country's antiretroviral (ARV) treatment programme, which now reaches 70,000 HIV-infected people, or about 40 percent of those who need them.

In 2005, 5,054 women received Nevirapine, an ARV drug that can lower the chances of a mother infecting her baby by up to 40 percent. This was almost twice the number who received the drug in 2004 but, according to UNAIDS, the total number of pregnant women in Malawi who accessed prevention of mother-to-child treatment (PMTCT) services was still only 3 percent.

This issue has grabbed my passion as transmission from mother to child is preventable.
In "developed" nations such as the U.S., hardly any children contract HIV during pregnancy, labor & delivery or breastfeeding.

Our organization is working with this issue. Our Hope health centers provide PMTCT services to HIV positive mothers and distributes nevirapine. There are obstacles to the treatment besides just receiving the drugs. As I am sure I have mentioned earlier, there is still stigma about even getting tested for HIV. Even when a mother has been tested, she may be hesitant to receive PMTCT services because she fears discrimination from others if she is noticed.

Another challenge is that the majority of women give birth at home/in their village and not at a health center. While this isn't necessarily a problem, since women are sent home with the drug to take during labor and give to their child within the first 72 hours of birth, it has been found that they are less likely to take the medication in this situation. It is hoped that teaching Traditional Birth Attendants (TBAs)about HIV & AIDS and the importance of taking nevirapine will help.

The positive is that we can reduce the chance of transmission to nearly zero with drugs and education.

HIV and AIDS funding, past and present

Here is some information about HIV & AIDS funding from the U.S. from I think it provides some telling information about the current government...

Spending per person living with HIV in the United States exceeds that in the Latin America and Caribbean region by a factor of 35, and is 1,000 times higher than in Africa.3

One of the main providers of global funding in the fight against AIDS is the United States government. In his State of the Union address in January 2003, President Bush promised the world the President's Emergency Plan For AIDS Relief (PEPFAR), a commitment to significantly increase US spending on HIV around the world. Planned to run for five years, the plan was intended to direct $15 billion to places where it was most needed. PEPFAR became an umbrella for all the existing work being done by the United States, and for all the HIV-related funding that was already going out through the Agency for International Development (USAID) and other government agencies. While this is a huge sum, it pales in comparison to the amounts spent on wars in Iraq and Afghanistan, and only $10 billion of this total was new money, $1 billion of which is provided to the Global Fund (see below); $5 billion was money that had been previously allocated, meaning that it would have to come from existing programmes.

PEPFAR funding is disbursed in accordance with the political views of the United States Government – meaning that 33% of the prevention funds are directed towards giving abstinence-only prevention messages. It has been suggested that the choice of countries that PEPFAR focuses on is politically motivated.

PEPFAR also refuses to fund projects and organisations that do not explicitly oppose prostitution, and allows faith-based organisations to refuse to provide information about proven methods of protection against HIV/AIDS (condoms) or to refuse to make referrals to clinics or organisations that offer critical prevention services and information.

The President's plan has a goal of having 2 million people on antiretroviral AIDS medicines (ARVs) by 2008, preventing seven million new infections, and caring for 10 million people infected with HIV or children who have been orphaned by AIDS.

PEPFAR is reluctant to direct AIDS funding to any government that the USA sees as connected to terrorism – although some countries that are so labelled would benefit from HIV-specific donations.

Severely affected countries tend to spend as much of their national budget as they are able on helping their own citizens.

Debt relief is certainly still a major factor in determining the efforts that poor countries are able to put into the fight against AIDS in future years. (Debt relief is a complicated issue...there are many perspectives on various sides of the issue).

More information can be found about PEPFAR including its methods, main beneficiaries and successes in our page on the President's Emergency Plan For AIDS Relief.

The good news is...I received the following email from my senator: Thank you for contacting me regarding the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008. I am very pleased that with my support, Congress has passed this comprehensive, life-saving legislation, which was signed into law by the President on July 30, 2008.

This measure reauthorizes the President’s Emergency Plan for AIDS Relief (PEPFAR), providing $48 billion over five years for HIV/AIDS treatment, care, and prevention worldwide. It sets spending for tuberculosis at $4 billion, and malaria at $5 billion, and authorizes $2 billion for fiscal year 2009 for the Global Fund To Fight AIDS, Tuberculosis, and Malaria. The bill also specifies that 10 percent of funding be designated for orphans and vulnerable children, increases focus on women and girls, and addresses gender-based violence. Furthermore, it repeals the travel ban for individuals who have been diagnosed HIV positive and instead puts this decision in the hands of the Secretary of Health and Human Services. Finally, it removes the one-third spending requirement on abstinence prevention efforts, which has proven to be ineffective.

Tuesday, July 15, 2008

Lack of sleep induced mush and some truth

I'm eating lunch and this piece of meat I just ate tasted like cat food smells. It's not too appetizing of an association. I am at the office but not really working because I stayed up all night to help Enock & Lisbeth, our country director, finish a USAID proposal for HIV/AIDS prevention. It was great. If we receive the funding, we will reach an additional 2 million people. (And if we don't, someone else will get the money for their project).I love the things I've been able to experience and contribute to in my job here. It kills me that I finally have a job I love and it is only for three months. It is a tease. But it reminds me of a good Buddhist principle...nothing is permanent. Anyway, I am hopeful that my experience here will help me get another job in Africa in the not too distance future (and a comparable job in the U.S. in the meantime).

Besides loving my job, I love it here. Today in the car on the way back to town from Chilangoma watching the beautiful scenery go by(we stayed at the Teacher Training College last night to work on the proposal there), I fell in love with Malawi. (It also helps that after three days of gray and cold, the sun is shining. I think living in California has ruined me forever. I now have the expectation that the sun should shine.)

It has definitely been a slow growing love, as some things are...not like the instant rapture I felt for Mali. But I find that as I grow personally and perhaps get older (a combination of experience and time) my emotions have found more of a middle ground, which I am grateful for.

I'm going to get a $13 massage for my aching shoulders...

Sunday, July 13, 2008

The most unhappy country in the world

I keep meaning to write that I take back my earlier support of Tsvangirai's decision to pull out of the Zimbabwean race for president. The violence continued and Zimbabwe is no closer to having Mugabe out of office.

There was a big article in the paper in Malawi about how Zimbabwe is the most unhappy country in the world. There are actually lots of articles and opinion pieces in the papers about Zimbabwe every day.

I was talking with some co-workers when everything was going down in Zimbabwe, and they told me that Mugabe had thought of conceding when Tsvangirai won the original election, but his advisors resisted because they would all be thrown in jail. I guess that's what happens in Africa: when leaders who have abused their power step down from office, they are arrested for the crimes they committed.

So...they asked me if Bush would be arrested when he stepped down! I was surprised by the question, not because there isn't reason for it, but just because it's not what we do in America, and I tried to explain that as best I could. What I also found telling is that a majority of people around the world know about the offenses of the Bush administration. It is taken as fact these days that we invaded Iraq under false pretenses. They also knew a lot about the shortfallings of the govt. in and around 9/11, things that have been debated with high tension in the U.S., although that discussion seems to have lost what little wind it did have.

Woman is...

John Lennon wrote a song called Woman is the n-word of the world. This sentiment is most definitely true in Africa. This is actually one area where I feel lucky to be an American. Women in America, (at least I can speak for middle class women) have it much better than women in most places in the world. There are so many things here that I feel like I would never put up with if I was a Malawian woman. But then again, that's because I was raised in a different country, a different culture, and tolerance levels differ.

However, the good news is this is no longer a silent issue. There are women's rights groups, laws that help women and social programs dealing with gender. In the partnership office, I come across a lot of organizations that want to fund programs for women or programs that have to do with gender relations.

Let me tell you how this issue impacts the spread of HIV/AIDS. Women are three times more likely to contract HIV/AIDS, both because of biological and cultural factors. Heterosexual sex is the number one mode of transmission here, and women often cannot negotiate safe sex. A man will not wear a condom or will not accept no. Many men also have affairs, which put their wives and families at risk.

We attended a community education meeting which was an outreach activity of one of our Hope centers. First off, most of the participants were women. (Right, so even though they are less able to protect themselves than men, twice as many women get tested in our health centers, even with the threat of violence from their husbands.)
A teaching drama was performed in which women went for VCT services (Voluntary Counseling and Testing). The women each gave a different scenario that is common here. One was afraid her husband would find out she had gone for testing, as he forbid her to do so. Another came because even though she is faithful, her husband is not. Another was found positive even though she believed her husband to be faithful..she vowed to bring him in for testing! (These are the pictures in my last slideshow).

It really hit home that more men need to be mobilized. Of course, there are good, great men that go for testing with their wives, or work at our health centers. But they need to become the norm rather than the exception.